© 2001 European Society of Cardiology
Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure even when atrial fibrillation is present
a Department of Cardiology, Montescano Medical Center, S. Maugeri Foundation Montescano Pavia, Italy
b Department of Cardiology, Ospedale A. Manzoni Lecco, Italy
* Corresponding author. Centro Medico Montescano, Via per Montescano 40, 27040 Montescano, Pavia, Italy. Tel.: +39-385-2471. E-mail address: e.traversi.montescano{at}fsm.it (E. Traversi).
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Abstract |
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Background and aims: In patients with chronic congestive heart failure a high pulmonary artery wedge pressure (PAWP) is associated with poor prognosis, severe symptoms and low exercise tolerance. When atrial fibrillation is present the non-invasive prediction of PAWP by Doppler echocardiography is generally considered to be not reliable.
Methods: In 51 consecutive patients with chronic heart failure, due to either ischemic and non-ischemic dilated cardiomyopathy, and atrial fibrillation simultaneous Doppler echocardiographic and hemodynamic studies were used to estimate PAWP. The power of the obtained multivariate equation was compared with that of previously developed equations and was then prospectively tested in a group of 15 patients.
Results: The deceleration rate (DR) of early diastolic mitral flow, the left ventricular iso-volumic relaxation time (IVRT) and the systolic fraction of pulmonary venous flow (SF) were independent predictors of PAWP and the following multivariable equation was derived: PAWP = 24.04 + 1.23 x DR – 0.089 x IVRT – 0.175 x SF. The correlation between invasive PAWP and the PAWP non-invasively estimated by this equation in the testing group was 0.91 (standard error of estimate = 3.2 mmHg). The mean difference was 0.93 and the standard error of differences was 2.7 mmHg.
Conclusion: In patients with chronic heart failure due to dilated cardiomyopathy who are in atrial fibrillation a relatively accurate estimation of PAWP can be obtained by Doppler echocardiography of mitral and pulmonary venous flow.
Received February 19, 2000; Revised August 30, 2000; Accepted October 12, 2000
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